CAHS F2F Form 001

COLLEGE OF ALLIED HEALTH SCIENCES

STATEMENT OF PARENTAL CONSENT

Dear Parents/Guardian:
Your child has expressed his/her intentions of joining the HOSPITAL AFFILIATION in his/her
RELATED LEARNING EXPERIENCE.

Title of Activity:
HOSPITAL AFFILIATION

to be held AY 2022-2023, First Semester at Public/Private Hospitals in Pangasinan

on
(DATE OF ACTIVITY) (PLACE)

If you are allowing your child to join the said activity, kindly fill-up the Reply Slip below before
September 12, 2022.

Should you have any questions please contact CAHS Office _________ local ___.

✂………………………………………………………………………………………………….
Statement of Parental Consent
Please be informed that the undersigned poses no objection to the participation of my son/daughter,

__________________________________________________________________________________
My son/daughter has expressed his/her intentions of joining the LIMITED FACE TO FACE activity to be
held in 1st semester AY 2022-2023 at PHINMA.

The PHINMA _____ CAHS will oversee the safety, behavior, and physical upkeep of your child but
the University and the accompanying clinical instructor/s of the named student shall not be held
liable for any accident, untoward incident or damage that may be caused to said student, there being
no fault or negligence on the part of the College.

Signature over printed name of parent Contact # of Parent

I hereby state that the information above is true

Endorsed By: and correct.

Signature and Date

 Name
Dean, College of Allied Health Sciences
Organization